title: Tumefactive demyelination: an unusual cause of a spontaneously resolving homonymous hemianopia.
abstract: A 21-year-old man presented to eye casualty complaining of altered vision associated with headache and vomiting upon waking. Clinical examination was unremarkable except for a right-sided homonymous hemianopia. The MRI scan of the brain revealed a space occupying lesion within the occipital lobe and MR spectroscopy highlighted this to be inflammatory in nature, most likely a tumefactive demyelinating lesion (TDL). Lumbar puncture displayed positive oligoclonal bands. The patient was managed conservatively and made a full recovery, with normal visual fields recorded after a 3 month follow-up. This is a case of a TDL manifesting itself as an unusual cause of homonymous hemianopia; misdiagnosis of TDL is common and potentially damaging to the patient.
authors.affiliation: Royal Liverpool & Broadgreen University Hospitals Trust, Liverpool, UK. r.dwivedi@doctors.org.uk
authors.forename: R A
authors.initials: RA
authors.lastname: Dwivedi
authors.forename: R E
authors.initials: RE
authors.lastname: Dwivedi
authors.forename: J M
authors.initials: JM
authors.lastname: Durnian
authors.forename: C A
authors.initials: CA
authors.lastname: Young
mesh_terms: D000328:Adult; D001921:Brain / Q000503:physiopathology; D003711:Demyelinating Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D003937:Diagnosis, Differential; D006423:Hemianopsia / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D013129:Spinal Puncture; D016896:Treatment Outcome